a clinical intervention program for tobacco prevention and cessation detroit, michigan
TRANSCRIPT
A Clinical Intervention Program for Tobacco
Prevention and CessationDetroit, Michigan
VODI’s Goal
Research, Design, and Implement
a comprehensive clinical intervention
program for tobacco cessation.
What is VODI?A Collaborative Partnership
Henry Ford Health System
St. John Health
The Detroit Medical Center
The Detroit Department of Health
Federally Qualified Health Centers
Political, Faith-based, and human service organizations
Part of the W.K. Kellogg Community Voices Initiative
What does VODI do?VODI provides free or low-cost health services to the uninsured and underserved
VODI focuses on primary care, pharmacy, lab, dental, care management, and pharmacy services
VODI is the “medical home” for low-income, uninsured residents of Detroit
A bit of background…
Detroit is 83% African AmericanThere is no “public health” hospitalThere are approximately 180,000 uninsured people in Detroit and the number served by VODI is 20,000 Detroit has 3 major universities, 2 dental schools and a community college system.
Who are VODI patients?live in Detroit
cannot qualify for Medicaid or other public insurance programs
are between the ages of 18 and 64
fall below 250% of the federal poverty level guidelines (average monthly pay rate is under $1000).
the average age of a VODI client is 39 years old.
Over half of VODI clients are employed.
The VODI Vision
TimeEnergyCommitment
Improve quality…reduce costs
VODI’s Tobacco Cessation Program
CMEHealth Education KiosksNicotine replacement and/or pharmacotherapy
Academic Detailing
Tobacco Cessation Counseling
Continuing Medical Education:“Oral Health & Tobacco
Cessation in a Primary Care Setting”
CD-ROM: University of Michigan – School of Dentistry
* 2 Websites
Accreditation: Wayne State University and the Detroit Medical Center
* 4 CME credits
Development of the CME
Content (provider focus groups)Technical SupportMedical ReviewMedia ConsultantsAccreditation
Continuing Medical Education
Identify the users
Determine readiness to quit
Tailor counseling based on readiness
CME Evaluation
Pre-test and Post-test questionnaires6-month follow-up survey
More than 100 providers have been trained
100 more in the next 2-3 months
CME Results – ScoresPre- and Post-Session Questionnaires
CME Pre-Test
CME Post-Test
Follow-up
Total Score
31% 53% 53%
Pretest: During the last week, how many patients have you counseled to quit smoking/using tobacco?
Mean number of patients: 7
During the last week, how many times have you recommended NRT or Zyban to assist them?
Mean number:2
Follow-up:
Question 1: Mean number of patients: 6
Question 2: Mean number 3
CME 6-Month Follow-up
Did the CME contain what they needed to counsel patients?Could they counsel based on readiness to quit after the CME?Did they find the information useful?
Health Education Kiosks
Used by over 9000 individualsProvides information on tobacco use and tips on quitting smoking.Gives us information about smoking rates and attitudes toward smoking among clinic patients.
The next steps to a Comprehensive Tobacco Cessation Program
Free Nicotine Replacement Therapy and/or PharmacotherapyAcademic DetailingTobacco cessation counseling and support programs
Academic Detailing
Various levels of interaction/approvals
ProviderAdministrationMedical DirectorHealth Care Systems
Academic Detailing
Assessments
Clinic Specific Plans
Form Revisions
Training
Follow-up/Program Maintenance
Assessments
What systems are in place?
Do they:1. designate tobacco use at each visit?2. assess patient’s readiness to quit?3. have any health education materials?4. document advice given?5. have any referral services in place?
Clinic Specific Plans
Health Education MaterialsVideos, posters, bannersFliers/magnets for referrals to counseling and/or Quit LineICD-9 CodesNRT/Zyban Cheat CardsMonthly newslettersDinner meetings/seminarsQuit smoking days at the clinics
Form Revisions
1. Intake/History Forms2. Vital Signs (SVS)3. Progress/Intervention Notes
Training
Let staff know what has been implemented and work with them for as long as it takesPresent data from CME pre-test,post-test and follow-upPresent data from the kiosksTeach use of educational materials as tools for talking to patientsPresent research based on their clinic demographicsStress the importance of using the prescriptions properlyTeach them how to refer patients with our tools
Follow-up/Program Maintenance
Stay in close contact with the clinicsAssign Champions in each clinic
Program Evaluation Tools
ICD-9 Code 305.1: Tobacco Use DisorderNicotine Replacement PrescriptionsMedical Chart AuditsCounseling/Quit Line Referrals
SustainabilityPotential Grant FundingDevelopment of a Business Plan to offer this program to HMO’s and private practicesProviding them with materials that can be copied or ordered at no costMImplementing permanent documentation through forms
Contact Breaking FreeBreaking Free
Gayle Walters Phone: 517-546-2169Email: [email protected]
VODI Tobacco Use Reduction ProjectDeirdre Shires Phone: 313-832-4246
Email: [email protected]
CME Program: http://oralhealth.dent.umich.edu/VODI/html/00/
about.html